Detachable end effectors

ABSTRACT

Methods and devices are provided for performing various procedures using interchangeable end effectors. In general, the methods and devices allow a surgeon to remotely and selectively attach various interchangeable surgical end effectors to a shaft located within a patient&#39;s body, thus allowing the surgeon to perform various procedures without the need to remove the shaft from the patient&#39;s body. In an exemplary embodiment, multiple end effectors can be introduced into a body cavity. The end effectors can be disassociated or separate from one another such that they float within the body cavity. A distal end of a shaft can be positioned within the body cavity and it can be used to selectively engage one of the end effectors. In particular, the device can be configured to allow each end effector to be remotely attached and detached from the distal end of the shaft.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/742,040 filed on Jan. 15, 2013 and entitled “Detachable EndEffectors,” which is a continuation of U.S. patent application Ser. No.11/693,976 (now U.S. Pat. No. 8,377,044) filed on Mar. 30, 2007 andentitled “Detachable End Effectors,” each of which is herebyincorporated by reference in its entirety.

FIELD OF THE INVENTION

The present invention relates to methods and devices for performingsurgical procedures using interchangeable end effectors.

BACKGROUND OF THE INVENTION

As the range of therapeutic endolumenal and transgastric treatmentsavailable to gastroenterologists and surgeons expands, the tools used toperform such procedures are becoming more complex. Increasinglysophisticated maneuvers demand greater functionality within the limitedspace offered by the gastrointestinal tract. Consequently, the size ofsurgical end effectors developed to achieve this functionality willincrease, preventing operation through a working channel of anendoscope, which is the traditional approach to endoscopic procedures.Unfortunately, if an instrument is not passed through an endoscope,articulation and control of a distal end of the instrument is difficultif not impossible.

Instruments have been developed that do provide control of toolsextending tangential to an endoscope. For example, accessory channelsthat run along side an endoscope have been developed with steeringmechanisms at the distal end for effecting movement of a tool insertedtherethrough. While this provides the advantage of articulationindependent of a working channel, the size of the tool cannot exceed thediameter of the body lumen, e.g., the esophagus, less the diameter ofthe endoscope.

Accordingly, there remains a need for methods and devices for deliveringend effectors through a body lumen without the size constraints requiredby a working channel, yet that allows for endoscopic control. There alsoremains a need for methods and devices for performing multiple surgicalprocedures using multiple end effectors without the need to exchange theend effectors through the working channel of an endo scope.

SUMMARY OF THE INVENTION

The present invention generally provides methods and devices forperforming various procedures using interchangeable end effectors. Ingeneral, the methods and devices allow a surgeon to remotely andselectively attach various interchangeable surgical end effectors to ashaft located within a patient's body, thus allowing the surgeon toperform various procedures without the need to remove the shaft from thepatient's body. In one embodiment, a modular surgical device is providedand includes a shaft having proximal and distal ends, a plurality of endeffectors interchangeably matable to the distal end of the shaft, and anengagement mechanism located on the distal end of the shaft andconfigurable between a first position in which the engagement mechanismmates one of the plurality of end effectors to the distal end of theshaft, and a second position in which the plurality of end effectors aredisassociated from the shaft and from one another. The engagementmechanism can be configured for mating the end effectors and the shaftin situ without assistance from additional devices. The device can alsoinclude a second shaft extending adjacent to the first shaft and havinga second engagement mechanism formed thereon and adapted to mate one ofthe plurality of end effectors to the second shaft such that movement ofthe second shaft is effective to actuate the end effector.

The engagement mechanism can have a variety of configurations. In oneembodiment, the engagement mechanism can be threads formed on a distalend of the shaft and adapted to mate with corresponding threads formedin a bore in at least one of the plurality of end effectors. The devicecan also include an anti-rotation mechanism formed on at least one of anouter sleeve disposed over the shaft and the plurality of end effectors.The anti-rotation mechanism can be adapted to maintain at least one ofthe plurality of end effectors in a fixed position relative to the outersleeve. In one embodiment, the anti-rotation mechanism can be anasymmetrical bore formed in one of the outer sleeve and at least one ofthe plurality of end effectors, and a protrusion formed on the other oneof the outer sleeve and at least one of the plurality of end effectors.The protrusion can be adapted to be received within the bore to preventrotation. In another embodiment, the anti-rotation mechanism can befirst and second magnets formed on the outer sleeve and the end effectorfor magnetic engagement. In yet another embodiment, the anti-rotationmechanism can be a grasping element formed on the outer sleeve andadapted to grasp at least one of the plurality of end effectors.

In yet another embodiment, the engagement mechanism can be a magnetformed on the distal end of the shaft and adapted to magnetically engagea magnet formed on at least one of the plurality of end effectors. Theengagement mechanism can also include a pusher disposed through theshaft and adapted to push an end effector out of engagement with theshaft. In an exemplary embodiment, the magnet on the shaft and themagnet on at least one of the plurality of end effectors are adapted tomagnetically align with one another in a predetermined orientation.

In other embodiments, the engagement mechanism can be a male memberadapted to mate with a female member formed on at least one of theplurality of end effectors. The male and female members can be, forexample, a pin and bore, a hook and loop, and a ball and grasper. Inanother embodiment, the engagement mechanism can be a plurality ofdeflectable members formed on the shaft and adapted to be disposedwithin a bore formed in at least one of the plurality of end effectors.The device can also include an inner shaft disposed within the shaft andadapted to expand the deflectable members into engagement with the boreformed in at least one of the plurality of end effectors. In yet anotherembodiment, the engagement mechanism can be an electromagnetic coildisposed within a distal end of the shaft and adapted to engage amagnetic shaft formed on at least one of the plurality of end effectors.

Various end effectors can also be used with the device including, forexample, a needle, a snare, a needle knife, a monopolar probe, a bipolarprobe, a clipping device, a retractor, a band ligator, scissors,graspers, irrigation devices, marking devices, etc.

In another embodiment, a modular surgical device is provided andincludes an elongate member having a proximal end with an actuator and adistal end with a mating element, and a plurality of end effectors forperforming surgical procedures. Each end effector can include a matingelement adapted to mate to the mating element on the elongate membersuch that the plurality of end effectors are interchangeably matable tothe elongate member. In use, movement of the actuator is effective tocause the mating element on the distal end of the elongate member tointerchangeably attach and detach the plurality of end effectors to theelongate member to allow the plurality of end effectors to beselectively and interchangeably mated to the elongate member when theend effectors are disposed within a body cavity. The mating element onthe elongate member can have a variety of configurations, and it can be,for example, threads, a magnet, a grasping element, a piston, a pin, ahook, a deflectable member, and an electromagnetic element. The devicecan also include a second elongate member extending adjacent to thefirst elongate member and having a mating element adapted to mate to acorresponding mating element on at least one of the plurality of endeffectors. Movement of a second actuator on the second elongate membercan be effective to actuate the end effector.

In yet another embodiment, a surgical method is provided and includesdelivering a plurality of end effectors to a body cavity of a patient,such as the stomach, such that the end effectors are disassociatedwithin one another and float within the body cavity. A distal end of ashaft is positioned within the body cavity and a proximal end of theshaft extends from the patient. An actuator on the proximal end of theshaft can be manipulated to cause the distal end of the shaft toremovably mate to one of the plurality of end effectors. Manipulatingthe actuator can be effective to cause an engagement mechanism locatedon the distal end of the shaft to engage and removably mate one of theplurality of end effectors to the distal end of the shaft. Manipulatingthe actuator can also be effective to detach the end effector from thedistal end of the shaft. In one embodiment, the method can furtherinclude manipulating a second actuator on a second shaft to mate adistal end of the second shaft to the end effector that is mated to thefirst shaft. The second shaft can be moved relative to the first shaftto perform a surgical procedure with the end effector. In an exemplaryembodiment the shaft is disposed through an endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is a schematic illustration of a generic modular device havinginterchangeable end effectors, showing one engagement mechanism;

FIG. 1B is a schematic illustration of a generic modular device havinginterchangeable end effectors, showing two engagement mechanisms;

FIG. 2A is a side, partially cross-sectional view of one embodiment ofan engagement mechanism that utilizes a threaded connection;

FIG. 2B is a side view of an alternate embodiment of a threaded shaftfor use with the engagement mechanism of FIG. 2A;

FIG. 2C is a side view of another embodiment of a threaded shaft for usewith the engagement mechanism of FIG. 2A;

FIG. 2D is a side, partially cross-sectional view of another embodimentof an engagement mechanism that utilizes two threaded connections;

FIG. 3A is a side perspective view of an engagement mechanism thatutilizes threads and an asymmetrical anti-rotation mechanism accordingto another embodiment;

FIG. 3B is a side view of another embodiment of an engagement mechanismthat uses threads and surface features to prevent rotation;

FIG. 3C is a side view of yet another embodiment of an engagementmechanism that uses threads and graspers to prevent rotation;

FIG. 3D is a side view of an engagement mechanism that uses threads anda pawl to prevent rotation according to another embodiment;

FIG. 3E is a side view of another embodiment of an engagement mechanismthat uses threads and a magnet to prevent rotation;

FIG. 4A is a side cross-sectional view of yet another embodiment of anengagement mechanism having a magnet for attachment and a pusher fordetachment;

FIG. 4B is a cross-sectional view of the magnets of FIG. 4A havingalignment features;

FIG. 5A is a perspective view of another embodiment of an engagementmechanism having male and female members, showing the male member aboutto be inserted through the female member;

FIG. 5B is a perspective view of the male member of FIG. 5A insertedthrough the female member;

FIG. 5C is a perspective view of the male member of FIG. 5C rotated tolock the male member within the female member;

FIG. 6A is a perspective view of another embodiment of an engagementmechanism that uses a pin and bore connection;

FIG. 6B is a perspective view of an engagement mechanism that uses ahook and loop connection according to another embodiment;

FIG. 6C is a perspective view of a ball and grasper engagement mechanismaccording to yet another embodiment;

FIG. 7A is a perspective view of yet another embodiment of an engagementmechanism having expanding fingers for engage a bore;

FIG. 7B is a cross-sectional view of the engagement mechanism of FIG. 7Ashowing the expanding fingers inserted into the bore;

FIG. 7C is a cross-sectional view of the engagement mechanism of FIG. 7Cshowing an inner shaft inserted into the expanding fingers to lock thefingers in the bore;

FIG. 8 is a cross-sectional view of another embodiment of an engagementmechanism that utilizes an electromagnetic connection;

FIG. 9 is a cross-sectional view of yet another embodiment of anengagement mechanism that uses pressure;

FIG. 10A is a side perspective view of one embodiment of an end effectorin the form of a needle;

FIG. 10B is a cross-sectional view of the needle of FIG. 10A, showingthe needle mated to a shaft using a magnetic engagement mechanism;

FIG. 10C is a cross-sectional view of the needle and shaft of FIG. 10A,showing the needle and shaft being retracted into an endoscope to removean end cap disposed over the tip of the needle;

FIG. 11A is a cross-sectional view of another embodiment of an endeffector in the form of a snare that uses a ball and grasper engagementmechanism;

FIG. 11B is a cross-sectional view of the snare of FIG. 11A, showing thegrasper engaging the ball on the snare to mate the snare to a shaft;

FIG. 12A is a side partially cross-sectional view of another embodimentof an end effector in the form of a monopolar probe that uses a threadedengagement mechanism;

FIG. 12B is a side partially cross-sectional view of the monopolar probeof FIG. 12A showing the probe being retracted into an endoscope togenerate a counter torque to allow a shaft to be unthreaded from theprobe;

FIG. 13A is a side view of yet another embodiment of an end effector inthe form of a bi-polar probe that uses a magnetic engagement mechanismwith an alignment feature;

FIG. 13B is a cross-sectional view of a distal end of a shaft of FIG.13A for mating to the probe;

FIG. 14A is a side partially cross-sectional view of an end effector inthe form of a clipping device that uses an electromagnetic engagementmechanism according to yet another embodiment;

FIG. 14B is a side partially cross-sectional view of the clipping deviceof FIG. 14A showing the device mated to a shaft;

FIG. 15 is a cross-sectional view of an end effector in the form of aretractor that uses a threaded engagement mechanism for mating to ashaft according to yet another embodiment;

FIG. 16A is a side view of another embodiment of an end effector in theform of a band ligator;

FIG. 16B is a side view of the band ligator of FIG. 16A about to bemated to a shaft using a hook and loop engagement mechanism;

FIG. 16C is a side cross-sectional view of the band ligator and shaft ofFIG. 16B mated to one another;

FIG. 17 is a side cross-sectional view of another embodiment of an endeffector in the form of a needle knife that uses magnetic and pressureengagement mechanisms;

FIG. 18A is a side view of yet another embodiment of an end effector inthe form of grasper;

FIG. 18B is a cross-sectional view of the scissors of FIG. 18A, showingexpanding fingers mating the grasper to a shaft, and a male/femaleengagement mechanism for actuator the grasper;

FIG. 19 is a cross-sectional view of yet another embodiment of an endeffector in the form of scissors, showing a magnetic engagementmechanism;

FIG. 20 is a side view of an end effector disposed within a capsule fordelivery to a patient;

FIG. 21A is a cross-sectional view of a stomach having an endoscopeinserted therethrough with a delivery wire passed through the endoscope;

FIG. 21B is a cross-sectional view of the stomach of FIG. 21A showingthe endoscope removed leaving the delivery wire in place;

FIG. 21C is a cross-sectional view of the stomach of FIG. 21B showingseveral end effectors being loaded onto the delivery wire;

FIG. 21D is a cross-sectional view of the stomach of FIG. 21C showing anendoscope being advanced over the delivery wire;

FIG. 22A is a side partially cross-sectional view of one embodiment ofhandle for actuating an end effector;

FIG. 22B is a side partially cross-sectional view of another embodimentof a handle for actuating an end effector; and

FIG. 22C is a side partially cross-sectional view of yet anotherembodiment of a handle for actuating an end effector.

DETAILED DESCRIPTION OF THE INVENTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

The present invention generally provides methods and devices forperforming various procedures using interchangeable end effectors. Ingeneral, the methods and devices allow a surgeon to remotely andselectively attach various interchangeable surgical end effectors to ashaft located within a patient's body, thus allowing the surgeon toperform various procedures without the need to remove the shaft from thepatient's body. Such a configuration also eliminates the sizeconstraints of a working channel, as the end effectors do not need to bepassed through a working channel since they are not attached to theshaft. Rather, the end effectors can be predisposed within the bodycavity. In an exemplary embodiment, multiple end effectors can beintroduced into a body cavity. The end effectors can be disassociated orseparate from one another such that they float within the body cavity. Adistal end of a shaft can be positioned within the body cavity and itcan be used to selectively engage one of the end effectors. Inparticular, the device can be configured to allow each end effector tobe remotely attached and detached from the distal end of the shaft. Forexample, a surgeon can actuate an actuation mechanism on the proximalend of the shaft to mate one of the end effectors to the distal end ofthe shaft without assistance from other tools and devices. After use ofthe end effector, the end effector can be released and another endeffector can be remotely attached to the distal end of the shaft.

A person skilled in the art will appreciate that the devices disclosedherein can be used in numerous surgical procedures. By way ofnon-limiting example, the devices can be used in endoscopic procedures,in which the device is introduced into the body through a naturalorifice, such as the oral, nasal, anal, or vaginal cavities. Forexample, the shaft of the device can be flexible and it can be advancedintralumenally, e.g., through the esophagus or colon, to position adistal end of the shaft at a surgical site. The surgical site can belocated within the lumen or within a body cavity or organ accessed viathe lumen. The devices can also be used in laparoscopic procedures, inwhich the device is introduced percutaneously. For example, the shaftcan be rigid or flexible and it can be inserted through tissue to accessa body cavity, such as the peritoneal cavity, or to access a holloworgan or a body lumen. The modular devices can also be used inprocedures that include a combination of endoscopic and laparoscopictechniques.

A person skilled in the art will also appreciate that the particularconfiguration of the end effector can vary depending on the type ofprocedure being performed, and that the term “end effector” as usedherein is intended to include any device that is configured to affect aparticular surgical outcome. By way of non-limiting example, suitableend effectors include mono-polar coagulators and probes, bi-polarcoagulators and probes, graspers, biopsy forceps, clipping devices,retractors, scissors, band ligators, suction devices, needles, needleknives and other cutting devices, sphinctertomes, snares, irrigationdevices, marking devices, etc.

FIGS. 1A and 1B are schematic illustrations of a generic modular device10 having interchangeable end effectors. In the embodiment shown in FIG.1A, the device 10 generally includes an elongate member 12 havingproximal and distal ends 12 p, 12 d. The particular configuration of theelongate member 12 can vary depending on the type of procedure beingformed. For example, for endoscopic procedures the elongate member 12can have a generally elongate flexible configuration, and the proximalend 12 p can be configured to remain outside of a patient's body whilethe distal end 12 d can be configured to be positioned within thepatient's body. The elongate member 12 can also be solid or it caninclude one of more lumens formed therethrough. The cross-sectionalshape of the elongate member 12 can also vary and does not need to betubular. Portions, such as the distal end, can also have a taperedconfiguration or some other shape to facilitate mating to an endeffector. The distal end can also include other features to facilitatemating, such as a water-tight seal, etc. The elongate member 12 can alsobe adapted to be disposed through an endoscope, or it can be integrallyformed with an endoscope. FIG. 1A also illustrates a generic endeffector 14 that is adapted to removably mate to the elongate member 12.The generic end effector 14 is intended to represent any end effectorused to effect a particular surgical outcome. The device 10 furtherincludes a first engagement mechanism, generically illustrated by arrow18, that is coupled between the elongate member 12 and the end effector14. Depending on the particular configuration of the end effector, thedevice 10 can also optionally include a second engagement mechanism,generically illustrated by arrow 19, that is coupled between a secondelongate member 13 and a portion 14 a of the end effector 14, as shownin FIG. 1B.

In use, each engagement mechanism 18, 19 can be configured to effect aparticular action. For example, the first engagement mechanism 18 can beconfigured to perform the action of attaching and detaching the endeffector 14 to and from the elongate member 12. The elongate member 12can be used to selectively toggle the engagement mechanism 18 between adisengaged position in which the end effector 14 is disassociated fromthe distal end 12 d of the elongate member 12 and can thus float withinthe body cavity, and an engaged position in which the end effector 14 ismated to the distal end 12 d of the elongate member 12. This allows asurgeon to remotely attach and detach an end effector 14 to the distalend 12 d of the elongate member 12, thus allowing multiple end effectors14 to be interchangeably mated to the distal end 12 d of the elongatemember 12 without removing the device 10 from the patient's body andwithout assistance from other tools and devices. Where the device 10includes a second engagement mechanism 19, as shown in FIG. 1B, thesecond engagement mechanism 19 can be configured to effect a seconddistinct action. The particular action is dependent on the configurationof the end effector 14. For example, where the end effector 14 is in theform of a clip applier having a pair of opposed jaws pivotally coupledto one another, the first engagement mechanism 18 can attach and detachthe clip applier to and from the elongate member 12 of the device 10,and the second engagement mechanism 19 can couple to a portion 14 a ofthe end effector 14, e.g., to the jaws of the clip applier, to effectthe action of opening and closing the jaws. The second elongate member13 can be used to actuate the second engagement mechanism 19. While notshown, the end effector can also be capable of performing a thirdaction, such as advancing and firing a clip or staple from the jaws.Thus, a third engagement mechanism can be provided to effect the actionof advancing and firing a clip or staple from the jaws. A third elongatemember can be used to actuate the third engagement mechanism.Accordingly, the modular device can include any number of engagementmechanisms, and the particular quantity can be dependent on theparticular quantity of actions that the end effector is capable ofperforming. Certain engagement mechanisms can also be configured toperform multiple actions. For example, a single engagement mechanism canbe used to close the jaws of a clip applier and to fire a clip from thejaws.

FIGS. 2A-9 illustrate various exemplary engagement mechanisms that canbe used to perform different actions, such as attachment/detachment,axial translation (also referred to as push/pull), and axial rotation.Each action can produce a desired outcome, such a clip firing, jawopening/closing, etc. While particular engagement mechanisms aredescribed and illustrated in connection with effecting particularactions, a person skilled in the art will appreciate that eachengagement mechanism can be modified to perform any action. Moreover,the various engagement mechanisms can be used alone or in variouscombinations with one another.

FIGS. 2A-3E illustrate various exemplary engagement mechanisms thatutilize a threaded connection to attach/detach an end effector to anelongate shaft, and/or to actuate the end effector. In the embodimentshown in FIG. 2A, a pure threaded connection is used to mate the endeffector 22 and an elongate shaft 20. In particular, the elongate shaft20 includes threads 20 t formed around a distal end 20 d thereof, andthe end effector 22 includes a lumen 24 having threads 24 t formedaround an inner surface thereof. The distal end 20 d of the elongateshaft 20 can be introduced into the lumen 24 and rotated relative to theend effector 22 to thereby threadably mate the shaft 20 to the endeffector 22. A person skilled in the art will appreciate that thethreaded connection can be reversed. That is, the threaded bore can beformed in the elongate shaft 20 and the end effector 22 can include ashaft with threads formed therearound.

FIG. 2A also illustrates one exemplary technique for enhancing thetorsional stiffness of the elongate shaft 20 to facilitate attachmentand detachment of an end effector 22 to and from the elongate shaft 20,to actuate a portion of the end effector 22, or to effect other motionsand actions. This technique is particularly advantageous for use withendoscopic devices, in which the rotational motion is translated down arelatively long shaft that extends from outside of a patient's bodythrough a body lumen. Given the long length and flexible construction ofmost flexible shafts, the shafts are often fairly compliant in torsion.Thus, it is advantageous to enhance the torsional strength of the shaftto facilitate the transfer of rotational motion from the proximal end ofthe shaft to the distal end of the shaft. As shown in FIG. 2A, this canbe achieved using one or more coils that are wound around, disposedwithin, or more preferably embedded in the shaft 20 and that extendalong a length of the shaft 20. In an exemplary embodiment, two coils 20a, 20 b extend through the shaft 20 in opposite directions such that thecoils 20 a, 20 b are cross-wound, as shown. The pitch of the coils 20 a,20 b, as well as the materials used to form the coils 20 a, 20 b, canvary to obtain a desired torsional strength. In one exemplaryembodiment, the pitch of each coil 20 a, 20 b can be less than 90°.

The pitch of the threads 20 t on the distal end 20 d of the elongateshaft 20 can also vary. FIG. 2B illustrates a distal end 20 d′ of theelongate shaft 20′ having threads 20 t′ formed thereon with a single orconstant pitch. In another embodiment, shown in FIG. 2C, the threadpitch can vary. For example, the distal end 20 d″ can include adistal-most portion 20 a″ having a first thread pitch, and an adjacentproximal portion 20 b″ having a second thread pitch that is greater thanthe first thread pitch. As a result, the first thread pitch will allowfor a quick attachment to the end effector, while the second threadpitch will provide fine control over movement of the end effectorrelative to the elongate shaft. This can be particularly advantageouswhere the engagement mechanism is used for both attachment/detachment ofthe end effector, and actuation, e.g., translation of the end effectorrelative to the shaft.

In another embodiment, multiple shafts can be used to engage the endeffector. For example, FIG. 2D illustrates two shafts 26, 28, eachhaving threads 26 t, 28 t formed thereon, for mating with threads 27 t,29 t formed in corresponding lumens or bores 27, 29 in the end effector25. While not shown, the two shafts 26, 28 can be housed within andextend through an outer shaft of the device. In use, the two shafts 26,28 can be used to engage a single end effector 25 as shown, or twoseparate end effectors. The shafts 26, 28 can also be used to actuatethe end effector 25, or portions thereof. In other embodiments, wherethe end effector 25 is a bipolar device, each shaft 26, 28 can be usedto carry the current.

In other embodiments, shown in FIGS. 3A-3E, the threaded engagementmechanism can also include an anti-rotation feature to prevent undesiredrotation of the end effector during use of the device. FIG. 3Aillustrates one embodiment of an anti-rotation feature in the form of anasymmetrical mating element. In particular, the distal end 30 d of theelongate shaft 30 s can include a bore or lumen 30 b formed therein andhaving an asymmetrical shape, such as a square shape. The proximal end30 p of the end effector 30 e can have a complementary shape that isadapted to be received within the bore 30 b formed in the elongate shaft30 s. As shown in FIG. 3A, the proximal end 30 p of the end effector 30e has a square shape that fits within the square bore 30 b in the shaft30 s. While the shape can be complementary, the surfaces do not need tobe congruent. For example, they can include cut-outs etc. As furthershown, a threaded shaft 30 t can extend through the lumen 30 b in theelongate shaft 30 s and it can extend into a threaded bore 30 o formedin the proximal end 30 p of the end effector 30 e. In use, as thethreaded shaft 30 t is rotated into the threaded bore 30 o formed in theend effector 30 e to mate the end effector 30 e to the elongate shaft 30s, the square proximal end 30 p of the end effector 30 e will be pulledinto the square bore 30 b in the elongate shaft 30 s to thereby preventundesired rotation of the end effector 30 e relative to the shaft 30 sduring use of the device. A person skilled in the art will appreciatethat the bore in the elongate shaft and the proximal end of the endeffector can have a variety of other shapes, such as rectangular,hexagonal, oval, etc., to prevent rotation of the end effector relativeto the elongate shaft. Moreover, the asymmetrical bore can be formed inthe end effector, and the outer surface of the elongate shaft can beshaped to be received within the bore.

FIG. 3B illustrates another embodiment of an anti-rotation mechanism foruse with a threaded engagement mechanism. In this embodiment, the distalend 32 d of the elongate shaft 32 s and the proximal end 32 p of the endeffector 32 e include surface features formed thereon or therein toprevent rotation of the two components relative to one another. Inparticular, the distal end 32 d of the elongate shaft 32 e includes aseries of ridges 32 r ₁ formed around an inner surface thereof, and theproximal end 32 p of the end effector 32 e includes corresponding ridges32 r ₂ formed around an outer surface thereof. In use, a threaded shaft32 t extending through the elongate shaft 32 s can be threaded into acorresponding threaded bore 32 o formed in the end effector 32 e. As theelongate shaft 32 s is advanced over the proximal end 32 p of the endeffector 32 e, the surface features 32 r ₁, 32 r ₂ will engage oneanother to prevent rotation of the end effector 32 e relative to theelongate shaft 32 s.

In another embodiment, shown in FIG. 3C, the distal end 34 d of theelongate shaft 34 s can include a grasping element formed thereon forgrasping the end effector 34 e to prevent rotation of the end effector34 e during use of the device. As shown, the grasping element is in theform of opposed arms 34 g that are pivotally coupled to the distal end34 d of the elongate shaft 34 s. The arms 34 g can be moved toward oneanother to engage corresponding detents 34 c formed in an outer surfaceof the end effector 34 e, thereby engaging the end effector 34 e.Various techniques known in the art can be used to move the arms 34 gbetween the open and closed positions including, for example, one ormore cables having a distal end coupled to the arms and a proximal endcoupled to a trigger formed on a handle of the device. Actuation of thetrigger can pull the cables, thereby pulling the arms 34 g toward oraway from one another. Alternatively, the arms 34 g can be biased to aclosed configuration to engage the end effector 34 e as the elongateshaft 34 s is advanced over the end effector 34 e. In use, a threadedshaft 34 t extending through the elongate shaft 34 s can be threadedinto a threaded bore 34 o formed in the end effector 34 e. As the endeffector 34 e is pulled toward the elongate shaft 34 s, the opposed arms34 g can close or be closed to engage the detents 34 c, therebypreventing rotation of the end effector 34 e relative to the elongateshaft 34 s.

In yet another embodiment, a pawl 36 x can be used to engage the endeffector 36 e to prevent rotation of the end effector 36 e relative tothe elongate shaft 36 s during use of the device. As shown in FIG. 3D,the pawl 36 x is pivotally coupled to the distal end of the elongateshaft 36 s, and the end effector 36 e includes a cut-out or detent 36 cformed on an outer surface thereof for receiving the pawl 36 x. In use,the elongate shaft 36 s can be advanced over and rotated relative to theend effector 36 e such that threads (not shown) formed within theelongate shaft 36 s engage corresponding threads (not shown) formed onan outer surface of the end effector 36 e. Once the pawl 36 x ispositioned adjacent to the cut-out 36 c, the pawl 36 x will extendthrough an elongate slot 36 y formed in the shaft 36 s and it willextend into and engage the cut-out 36 c in the end effector 36 e,thereby preventing rotation of the end effector 36 e relative to theelongate shaft 36 s. In one embodiment, the pawl 36 x can bespring-loaded to bias the pawl 36 x toward and into the cut-out 36 c. Asthe elongate shaft 36 s is threaded over the end effector 36 e, the pawl36 x will extend through the slot 36 y and slide along the end effector36 e eventually extending into the cut-out 36 c formed in the outersurface of the end effector 36 e. The biasing mechanism can beconfigured to allow the pawl 36 x to be released from the cut-out 36 cwhen a significant force is applied thereto, i.e., by rotating theelongate shaft 36 s in an opposite direction to release the end effector36 e. Alternatively, rather than having a spring-loaded pawl 36 x, anactuator can be used to move the pawl 36 x between an initial positionand an engaged position in which the pawl 36 x engages the cut-out 36 c.The actuator can be, for example, a tube that is slid over the pawl 36 xor a cable or wire that is coupled to the pawl 36 x and that moves thepawl 36 x relative to the elongate shaft 36 s.

In yet another embodiment, one or more magnets can be used to preventrotation of the elongate shaft relative to the end effector. As shown inFIG. 3E, the distal end 38 d of the elongate shaft 38 s includes amagnet 38 m ₁ mated thereto, and the proximal end 38 p of the endeffector 38 e includes a corresponding magnet 38 m ₂ mated thereto. Themagnets 38 m ₁, 38 m ₂ have opposite polarities to allow the magnets 38m ₁, 38 m ₂ to magnetically engage one another when the elongate shaft38 s is positioned in proximity to the end effector 38 e. In use, as athreaded shaft 38 t extending through the elongate shaft 38 s isthreaded into a corresponding threaded bore (not shown) formed in theend effector 38 e, the magnets 38 m ₁, 38 m ₂ will engage one another tothereby prevent undesired rotation of the end effector 38 e relative tothe elongate shaft 38 s during use of the device.

FIG. 4A illustrates another embodiment of an engagement mechanism forperforming different actions, such as attachment/detachment and axialtranslation (push/pull). In this embodiment, the engagement mechanismincludes two components: an attachment mechanism and a detachmentmechanism. The attachment mechanism is in the form of a magnet 44 a thatis disposed around a distal end 40 d of a shaft 40 s and a correspondingmagnet 44 b of opposite polarity disposed around the proximal end of theend effector 42. The magnets 44 a, 44 b on the shaft 40 s and endeffector 42 can have various configurations depending on theconfigurations of the shaft 40 s and end effector 42. As shown in FIG.4A, the shaft 40 s and end effector 42 each have a generally elongatehollow cylindrical configuration, and thus the magnets 44 a, 44 b have agenerally cylindrical configuration with a bore extending therethroughand aligned with an inner lumen of the shaft 40 s and end effector 42.The magnets 44 a, 44 b can be mated to the shaft 40 s and end effector42 using various techniques known in the art, including adhesives, athreaded connection, etc. The magnets 44 a, 44 b can also optionally beconfigured to axially align the elongate shaft 40 s with the endeffector 42. For example, each magnet 44 a, 44 b can be constructed withmultiple alternating polarities. FIG. 4B illustrates each magnet 44 a,44 b having four polarities that alternate around the perimeter thereof.Thus, when the end effector 42 and elongate shaft 40 s are placed intoproximity with each other, the opposite polarities will align with oneanother to thereby axially align the end effector 42 and the shaft 40 s.Returning back to FIG. 4A, the detachment mechanism is in the form of apusher 46 a that is slidably disposed within the shaft 40 s, and anabutment or protrusion 46 b that is formed on an inner surface of theend effector 42. The pusher 46 a can be, for example, a generallyelongate rod that extends through the length elongate shaft 40 s toallow a user to grasp a proximal end of the pusher 46 a and slidablymove the pusher 46 a relative to the elongate shaft 40 s. In use, themagnet 44A on the distal end 40 d of the shaft 40 s can be positionedadjacent to the end effector 42 to be attached thereto. The two magnets44 a, 44 b will engage one another to mate the end effector 42 to theshaft 40 s. In order to release the end effector 42 from engagement withthe shaft 40 s, the pusher 46 a can be advanced distally through theshaft 40 s and into the end effector 42 to abut against the protrusion46 b formed within the proximal end of the end effector 42. The pusher46 a can thus push the end effector 42 away from and out of engagementwith the shaft 40 s, thereby releasing the end effector 42. A personskilled in the art will appreciate that other techniques can be used todetach the end effector 42 from the shaft 40 s. For example, the endeffector 42 could be positioned adjacent to a tissue wall and the shaft40 s could be manipulated to force the end effector 42 to detach fromthe shaft 40 s.

FIGS. 5A-7C illustrate other exemplary engagement mechanisms used toperform different actions, such as attachment/detachment and axialtranslation (push/pull). In these embodiments, the engagement mechanismsutilize a male/female mating connection. Turning first to FIGS. 5A-5B,the engagement mechanism is in the form of a male member 52 disposed ona distal end 50 d of an elongate shaft 50, and a corresponding femalemember 56 formed within a wall 54. While not shown, the elongate shaft50 can be slidably disposed through an outer shaft of the device, andthe wall 54 can be formed on or within an end effector. The particularshape of the male and female members can vary, but in the illustratedembodiment the male member 52 has a generally elongate rectangularshape, and the female member 56 is in the form of a complementaryrectangular bore. While the shape of the male and female members may becomplementary, the surfaces do not need to be congruent. The male andfemale members can include cut-outs or other features. In use, the malemember 52 can be aligned with and advanced through the female member 56in the wall 54, as shown in FIG. 5B. Once positioned through the femalemember 56, the male member 52 can be rotated, e.g., 90°, relative to thefemale member 56, thereby locking the male and female members 52, 56 asshown in FIG. 5C. A person skilled in the art will appreciate that themale and female members can have a variety of other shapes and sizes.

FIG. 6A illustrates another embodiment of a male and female matingelement. In this embodiment, the male member is in the form of a pin 60p and the female member is in the form of a bore 60 b. In particular,the male pin 60 p is formed on and extends laterally outward from a bodylocated on a distal end 60 d of a shaft 60 s. The shaft 60 s can beslidably disposed through an outer shaft 60 o of the device. The femalebore 60 b is also formed in and extends laterally through a body locatedon a proximal end of a shaft 60 s. The shaft 60 s can be coupled to anddisposed within an outer shaft or housing 60 h of the end effector 60 e.In use, the male pin 60 p is positioned through the bore 60 b, and theouter shaft 60 o is advanced over the bodies and toward the outer shaftor housing 60 h of the end effector 60 e, thereby engaging the bodies toprevent the pin 60 p from being removed from the bore 60 b. To releasethe end effector 60 e, the outer shaft 60 o can be retracted relative tothe end effector 60 e, thereby allowing the pin 60 p to be released fromthe bore 60 b.

In a similar embodiment, shown in FIG. 6B, the pin and bore can bereplaced with a hook 62 h and loop 62 l. In particular, a male hook 62 hcan be formed on a distal end of an elongate shaft 62 s extendingthrough an outer shaft 62 o, and a female loop 62 l can be formed in aproximal end of an elongate shaft 62 a extending through an outer shaftor housing 62 h of the end effector. In use, the hook 62 h can bepositioned to engage the loop 62 l, thereby mating the end effector tothe elongate shaft 62 s. The outer shaft 62 o can optionally be advancedover the hook and loop 62 h, 621 once mated to prevent detachment of thehook and loop 62 h, 621 until desired.

In another embodiment, a ball and grasper can be used. FIG. 6Cillustrates opposed grasper arms 64 g extending from a distal end of anouter shaft 64 o, and a ball 64 b formed on a proximal end of a shaft 64a extending proximally from an outer shaft or housing 64 h of the endeffector. The grasper arms 64 g can be positioned around the ball 64 b,and the outer shaft 64 o can be advanced distally over the grasper arms64 g to close the arms 64 g and thereby cause the arms 64 g to engagethe ball 64 b. In the closed position, the grasper can control movementof the end effector in various directions including axial rotation andtranslation. To release the end effector from the shaft 64 o, the outershaft 64 o can be moved proximally thus allowing the grasper arms 64 gto open up and release the ball 64 b.

FIGS. 7A-7B illustrate another embodiment of an engagement mechanism inthe form of deflectable fingers. In this embodiment, the distal end 70 dof the elongate shaft 70 includes several deflectable fingers 70 fformed therearound. The fingers 70 f can be formed by cutting one ormore longitudinally oriented slots in the shaft 70. Each finger can alsoinclude a flange 71 f formed on an outer surface of a distal-most endthereof. The end effector 72 can include a bore 72 b formed therein andconfigured to receive the fingers 70 f. In use, the fingers 70 f can bebiased to a closed configuration, in which they are sized to be receivedwithin the bore 72 b in the end effector 72. Once disposed through thebore 72 b, as shown in FIG. 7B, an expander element, such as an innershaft 74, can be advanced through the elongate shaft 70 to therebyexpand the fingers 70 f radially outward. As a result, the flanges 71 fon the fingers 70 f will engage the wall that surrounds the bore 72 b,as shown in FIG. 7C, thereby preventing removal of the fingers 70 f fromthe end effector 72. To release the end effector 72 from the shaft 70,the inner shaft 74 can be moved proximally to allow the fingers 70 f tocollapse toward one another and thus be pulled out through the bore 72b.

FIG. 8 illustrates another exemplary embodiment of an engagementmechanism for performing various actions, such as attachment/detachmentand/or actuation. In this embodiment, the engagement mechanism utilizeselectromagnetic energy to effect a desired action. In particular, theengagement mechanism is in the form of a magnetic shaft 80 (or a shaftwhich contains a ferromagnetic material such as iron) that is housedwithin an electromagnetic coil 82. The electromagnetic coil 82 can bedisposed within a distal portion of an outer elongate shaft 84, which ispreferably formed from an insulative material. The configuration of thecoil 82 can vary, but in an exemplary embodiment the coil 82 isconfigured to produce a magnetic field when energy is delivered thereto.The length and size of the coil 82 can vary depending on the strength ofthe magnetic field needed to actuate the magnetic shaft 80. In order todeliver energy to the coil 82, first and second electrical leads 86 a,86 b can be coupled to the coil 82. In the illustrated embodiment, apositive lead 86 a is coupled to a proximal end of the coil 82, and anegative lead 86 b is coupled to a distal end of the coil 82. The leads86 a, 86 b can be standard conductive wires having an insulative coatingdisposed there over, and they can extend through the outer shaft 84, beembedded within the walls of the outer shaft 84, or extend along anexternal surface of the outer shaft 84.

In use, when energy is delivered to the coil 82 the generated magneticfield applies a force to the magnetic shaft 80, causing the magneticshaft 80 to translate along a longitudinal axis A of the device. Thedirection of movement, which is controlled by the direction of currentflow through the coil 82, can vary depending on the desired action to beperformed. For example, in one embodiment the magnetic shaft 80 can beconfigured to perform the action of attaching and detaching an endeffector to and from the distal end of the outer shaft 84. Inparticular, the distal end of the magnetic shaft 80 can be configured tomagnetically engage a magnet formed on a proximal end of an end effectorto thereby attach the end effector to outer 84. In this embodiment,energy activation is thus preferably effective to translate the magneticshaft 80 distally relative to the outer shaft 84 to cause the distal endof the magnetic shaft 80 to extend a distance beyond a distal end of theouter shaft 84. The distal end of the magnetic shaft 80 can thus bepositioned adjacent to and engage the magnet formed on the end effector.When energy delivery is terminated, the magnetic shaft 80 will moveproximally such that it is retracted within the outer shaft 84. As aresult, the magnetic shaft 80 will disengage from the end effector,thereby releasing the end effector from the outer shaft 84. A second endeffector can then be attached to the device if necessary.

In another embodiment, the distal end of the magnetic shaft 80 can beconfigured to perform other actions, such as translating a portion of anend effector to open and close jaws, move a cutting element, advance aclip or staple, etc. For example, where the end effector includesopposed jaws that are pivotally coupled to one another, the magneticshaft 80 can be configured to magnetically engage a magnet formed on aclevis that is coupled to one or both of the jaws. When energy isdelivered to the coil 82, the magnetic shaft 80 can translate in a firstdirection, e.g., proximally within the outer shaft 84, to pull theclevis proximally thereby moving the jaws to a first position, e.g., aclosed position. When energy delivery is terminated, the magnetic shaft80 will translate in an opposite direction, e.g., distally within theouter shaft 84, to push the clevis distally, thereby moving the jaws toa second position, e.g., an open position. Depending on theconfiguration of the end effector, an alternating current can alsooptionally be used to continuously translate the magnetic shaft 80proximally and distally. A person skilled in the art will appreciatethat, where the electromagnetic engagement mechanism is used to performan action other than attachment and detachment of the end effector toand from the outer shaft, a second engagement mechanism is preferablyprovided to perform the action of attachment and detachment.

FIG. 9 illustrates yet another embodiment of an engagement mechanism. Inthis embodiment, the engagement mechanism utilizes pressure. Inparticular, the elongate shaft 90 can be coupled to a pneumatic orhydraulic pressure actuator for generating a force within the elongateshaft 90. The end effector can include a piston 92 formed on a proximalend thereof and adapted to be received within the elongate shaft 90. Inuse, the pneumatic or hydraulic pressure actuator can be activated tomove the piston 92 proximally and distally relative to the elongateshaft 90. This is particularly advantageous for use in actuating an endeffector. A separate engagement mechanism can be providing for attachingand detaching the end effector to the elongate shaft.

As indicated above, the various engagement mechanisms can be used in anycombination to perform various actions, such as attachment/detachment,and actuation, including axial translation (push/pull movement), andaxial rotation. FIGS. 10A-19 illustrate various exemplary devices thatutilize one or more of the above-described engagement mechanisms toattach/detach and/or actuate an end effector.

FIGS. 10A-10C illustrate an end effector in the form of a surgicalneedle 100. The surgical needle 100 has a generally elongate hollowconfiguration with a sharp tissue-penetrating tip 102. A protective cap104 can be disposed over the tissue-penetrating tip 102 so as to preventundesired penetration of tissue prior to attaching the needle 100 to ashaft. Thus, with the protective tip 104, the needle 100 can beintroduced into a body cavity and can float in the body cavity until itis ready for use. While any of the various engagement techniquespreviously described can be used, in this embodiment the needle 100 usesa magnetic engagement and a pusher similar to that previously describedwith respect to FIG. 4A to attach and detach the needle. In particular,the needle 100 can be formed from a magnetic material, such as aferromagnetic material, and the distal end 106 d of the shaft 106 caninclude a magnet 107 disposed therein for mating to the needle 100.While the position of the magnet 107 on the shaft 106 can vary, in theillustrated embodiment the magnet 107 is disposed around and recessedwithin the distal end 106 d of the shaft 106. Thus, the shaft 106 can beguided to position the shaft 106 around the proximal end of the needle100, thereby attaching the needle 100 to the shaft 106. Once attached,the protective cap 104 can be removed by advancing an outer shaft, suchas an endoscope 109 over the shaft 106, or retracting the shaft 106relative to an endoscope 109 through which the shaft 106 is inserted, topush the protective cap 104 off of the needle 100, as shown in FIG. 10C.The needle can then be used to inject materials into the body and/or topuncture tissue, for example, through port 105. When the procedure iscomplete, an inner sheath or pusher 108 disposed within the shaft 106can be advanced distally to abut the proximal end of the needle 100 andthereby push the needle 100 out of the shaft 106 to detach the needle100. Prior to detachment, the shaft 106 can optionally be manipulated toinsert the needle 100 back into the protective cap 104, which isfloating in the body lumen. Alternatively, the shaft 106 can be removedthrough the endoscope 109 with the needle 100 attached thereto so thatthe needle 100 does not need to remain in the body.

FIGS. 11A-11B illustrates another embodiment of an end effector in theform of a snare 110. The snare 110 utilizes the ball and grasperengagement mechanism previously discussed with respect to FIG. 6C toattach and detach the snare 110 to the shaft 112 and to actuate thesnare 110. As shown, the snare 110 is in the form of a wire that isshaped into a snare loop and that includes two ends that are mated toone another and that have a ball 1106 mated thereto. The shaft 112includes a grasper 114 extending therethrough with opposed arms 114 a,114 b on the distal end that are biased toward an open configuration.When the grasper 114 is advanced distally beyond a distal end of theshaft 112, the arms 114 a, 114 b are open and can be positioned aroundthe ball 110 b on the snare 110. The shaft 112 can then be advanceddistally over the grasper arms 114 a, 114 b to bring the arms 114 a, 114b together, thereby causing the arms 114 a, 114 b to engage the ball 110b and thus attach the snare 110 to the shaft 112, as shown in FIG. 11B.Once attached, the grasper 114 can be moved proximally and distallywithin the shaft 112 to open and close the snare loop.

FIGS. 12A and 12B illustrate a monopolar probe end effector 120 having athreaded engagement mechanism for attachment and detachment. In general,the monopolar probe 120 has an elongate shape with at least one activeelectrode 122 disposed therearound. FIGS. 12A and 12B illustrate theelectrode 122 coiled around the probe 120. A proximal end of the probe120 includes a cavity 120 c formed therein and having threads 120 t formating with corresponding threads 124 t on a distal end of a shaft 124.The threaded engagement mechanism is similar to that previouslydescribed with respect to FIG. 2A. In use, the distal end of the shaft124 can be manipulated and rotated to thread the distal end into thecavity 120 c formed in the probe 120, thereby mating the probe 120 tothe shaft 124. In order to deliver energy to the electrode 122, theprobe 120 and shaft 124 can include electrical connectors. While variouselectrical connectors can be used, FIG. 12A illustrates a conductivespring 126 disposed within the cavity 120 c in the probe 120 and inelectrical communication with the active electrode 122. A conductivematerial, such as a wire 124 w or other member, can extend through theshaft 124 and it can be positioned such that, when the shaft 124 andprobe 120 are mated, the conductive wire 124 w comes into contact withthe conductive spring 126. The spring 126 can be compressed within thecavity 120 c as the probe 120 and shaft 124 are mated to ensure contactbetween the two components. Once connected, energy can be deliveredthrough the conductive wire 124 w to the spring 126 and thus to theelectrode 122, thereby allowing the probe 120 to be used to ablate orotherwise treat tissue. Once the procedure is complete, the probe 120can be removed from the shaft 124 by unthreading the shaft 124 from theprobe 120. In an exemplary embodiment, the probe 120 has an outerdiameter that is greater than an outer diameter of the shaft 124 toallow the probe 120 to abut against a distal end of an outer sheath 128,such as an endoscope, when the shaft 124 is retracted, as shown in FIG.12B. Friction will thus be generated between the proximal end of theprobe 120 and the outer sheath 128 to provide counter torque as theshaft 124 is rotated and unthreaded from the probe 120. In otherembodiments, an insulated electrode path can extend to an exteriorportion of an end effector to enable the end effector to contact tissueand allow the application of radio frequency energy to the tissue usinga conventional cautery tool. The end effectors can also be configured todeliver other forms of energy, such as microwave and ultrasonic energy.

FIG. 13A illustrates a bipolar probe end effector 130 having a magneticengagement mechanism and pusher for attaching and detaching the probe toand from the shaft. In general, the bipolar probe 130 is similar to themonopolar probe but includes two electrodes 132 a, 132 b disposedtherearound. Each electrode 132 a, 132 b can include a proximal end 133a, 133 b that extends proximally from the probe 130. The shaft 134 caninclude two conductive members or leads 136 a, 136 b extendingtherethrough for delivering energy to each electrode 132 a, 132 b. Theleads 136 a, 136 b can extend into two bores 137 a, 137 b formed in thedistal end of the shaft 134 for receiving the proximal ends 133 a, 133 bof the electrodes 132 a, 132 b, a shown in FIG. 13B. Thus, when theelectrodes 132 a, 132 b are inserted into the bores 137 a, 137 b theelectrodes 132 a, 132 b will contact the leads 136 a, 136 b, therebyelectrically connecting the probe 130 to the shaft 134. In order to matethe probe 130 to the shaft 134, FIG. 13A illustrates a magnet 138 adisposed on the distal end of the shaft 134 and a magnet 138 b disposedon the proximal end of the probe 130. In order to align the probe 130with the shaft 134 so as to cause the electrodes 132 a, 132 b to extendinto the bores 137 a, 137 b and mate to the leads 136 a, 136 b, themagnets 138 a, 138 b can have a configuration as previously describedwith respect to FIG. 4B. Once mated, the probe 130 can be used toperform various surgical procedures. When the procedure is complete, theshaft 134 can include a pusher 139 extending therethrough and adapted tobe advanced distally to push the probe 130 off of and out of magneticengagement with the shaft 134.

FIGS. 14A and 14 b illustrate another embodiment of an end effector inthe form of a clipping device 140. As shown, the clipping device 140generally includes opposed legs 142 a, 142 b adapted to receive tissuetherebetween, and a locking mechanism 144 adapted to slide over the legs142 a, 142 b to close and lock the legs 142 a, 142 b in a closedposition. In this embodiment, the clipping device 140 utilizes anelectromagnetic engagement mechanism, such as the engagement mechanismpreviously described with respect to FIG. 8, for attachment/detachmentand for actuation. In particular, the proximal end of the clip includesa magnetic shaft 145, and the distal end of the shaft 146 includes anelectromagnetic coil disposed therein. When energy is delivered to thecoil, the magnetic shaft 145 is pulled into the shaft 146. A distalhousing 146 h on the shaft 146 will abut against the locking mechanism144 to advance the locking mechanism 144 over the legs 142 a, 142 b,thereby closing the clip 140, as shown in FIG. 14B. Further proximalmovement of the magnetic shaft 145 within shaft 146 will cause afrangible portion 145 f on the magnetic shaft 145 to break, therebyreleasing the clip. The frangible portion 145 f can be a weakened regionof material formed by altering the physical or chemical structure of theshaft 145.

FIG. 15 illustrates another embodiment of an end effector in the form ofa retractor 150. In this embodiment, the retractor 150 is shown having apure threaded engagement mechanism, as previously described with respectto FIG. 2A, for attachment/detachment. A threaded distal end 152 d ofthe outer shaft 152 can be inserted into a threaded bore 150 b formed inthe proximal end of the retractor 150 to mate the retractor 150 to theshaft 152. The shaft 152 can then be manipulated to use the retractor150 to retract tissue. Once the procedure is complete, the shaft 152 canbe unthreaded from the retractor 150. In an exemplary embodiment, theshaft 152 is retracted into an endoscope through which it is disposedsuch that the proximal end of the retractor 150 abuts against the distalend of the endoscope to create a counter torque as the shaft 152 isunthreaded from the retractor 150.

FIGS. 16A-16C illustrates yet another embodiment of an end effector inthe form of a band ligator 160. In this embodiment, the band ligator 160uses a hook and loop engagement mechanism, as previously described withrespect to FIG. 6B, for attachment/detachment and for actuation. Inparticular, the band ligator 160 generally includes a rigid cylindricalsection 160 a for holding a plurality of elastic bands 161, and anelastic cuff 160 b extending from the rigid cylindrical section 160 afor mating to the distal end of an elongate shaft 164. The elastic cuff160 b can have a reduced diameter as compared to the cylindrical section160 a to allow the cuff 160 b to be received within the distal end ofthe elongate shaft 164, i.e., an endoscope in the illustratedembodiment. In order to mate the band ligator 160 to the elongate shaft164, a hook 166 can extend from the distal end of the elongate shaft 164and it can be manipulated to engage a corresponding loop 162 formed on aproximal end of the band ligator 160. Once engaged, the hook 166 can beretracted into the elongate shaft 164 to pull the elastic cuff 160 binto or around the distal end of the elongate shaft 164. The loop 162can include a proximal end that extends through the cylindrical section160 a and the cuff 160 b, and that is threaded through the elastic bands161. Once the elastic cuff 160 b is received in or around the distal endof the shaft 164, further tension applied to the hook 166 will cause thehook 166 to pull the elastic bands 161 distally. When positionedproperly, each band 161 can be advanced distally along the cylindricalsection until the band 161 is released whereby it engages tissue. In anexemplary embodiment, suction is applied through the shaft 164 and theband ligator 160 to suction tissue to be ligated into the cylindricalportion 160 a.

FIG. 17 illustrates a needle knife end effector 170 that utilizesmagnetic and pressure engagement mechanisms for attachment/detachmentand actuation, such as those previously described with respect to FIGS.4A and 9. As shown, the needle knife 170 is in the form of a smalldiameter wire 171 disposed through a housing or plastic sheath 172. Thehousing 172 can include a magnet 173 formed on a proximal end thereoffor mating with a corresponding magnet 175 formed on a distal end of theshaft 174. The distal end 171 d of the wire 171 is configured to cuttissue, and the proximal end 171 p of the wire 171 can be sized to bereceived within a distal end of a sheath 76 disposed within the shaft174 to permit piston actuation of the needle knife 170. In particular,pneumatic pressure, hydraulic pressure, or other forces can be used tomove the needle knife 170 proximally and distally relative to the shaft174. The sheath 176 can also be conductive to allow energy to bedelivered through the sheath 176 and to the needle knife 170.

FIGS. 18A and 18B illustrate yet another embodiment of an end effectorhaving an engagement mechanism that utilizes deflectable fingers forattachment/detachment as previously described with respect to FIGS.7A-7B, and a male/female engagement mechanism for actuation aspreviously described with respect to FIGS. 5A-5B. In this embodiment,the end effector is in the form of scissors. As shown, the scissors 180include first and second cutting jaws 182 a, 182 b that are pivotallycoupled to one another and to a clevis 184. A proximal end of each jaw182 a, 182 b is coupled to a connector 183 a, 183 b that is mated to anactuator sleeve 186 disposed over the clevis 184. The clevis 184 caninclude a female bore 184 a formed therein and having a shape adapted toreceive a male member 188 m on a distal end of a shaft 188 such thatrotation of the male member 188 m relative to the female member 184 a,as previously described with respect to FIGS. 5A-5B, will lock theclevis 184 to the shaft 188. Once the shaft 188 is mated to the clevis184, an outer sleeve 189 can be advanced over the shaft 188 to insertdeflectable fingers 189 f formed on the distal end of the outer sleeve189 into a proximal end of the actuator sleeve 186 disposed over theclevis 184. An inner shaft 187 can then be advanced distally into theouter sleeve 189 to cause the deflectable fingers 189 f to expandoutward and engage the actuator sleeve 186. Once mated, the shaft 188can be moved proximally and distally to move the clevis 184 proximallyand distally, thereby opening and closing the jaws. While not shown, theclevis 184 can optionally be biased to a distal position. When theprocedure is complete, the inner shaft 188 can be moved proximally,thereby allowing the deflectable fingers 189 f to move inward such thatthe outer sleeve 189 can be removed from the activator sleeve 186. Theshaft 188 can be removed by rotating it to align the male member 188 mwith the female bore 184 a, and pulling it proximally to pull the malemember 188 m through the female bore 184 a.

FIG. 19 illustrates another embodiment of an end effector 190 havingopposed jaws 192 a, 192 b. In this embodiment, the jaws 192 a, 192 b arein the form of graspers and the device includes a threaded engagementmechanism for attaching and detaching the end effector to and from theshaft 194, and a magnet and pusher for actuating, i.e., opening andclosing, the jaws 192 a, 192 b, as previously described with respect toFIG. 4A. As shown, the jaws 192 a, 192 b are mated to a clevis 193, asdescribed above with respect to FIGS. 18A and 18B, and connectors 192 c,192 d extend between the jaws 192 a, 192 b and an actuating sleeve 196.The outer surface of the distal end of the shaft 194 includes threads194 t formed thereon for mating with corresponding threads 194 t formedwithin the proximal end of the actuator sleeve 196. A magnet 194 m islocated on a distal end of the shaft 194 and is matable to a magnet 196m of opposite polarity disposed within a proximal end of the actuatorsleeve 196. The magnets 194 m, 196 m can serve two purposes. First, themagnets 194 m, 196 m can be used to pull the shaft 194 and end effector190 toward one another, thereby allowing the shaft 194 to be rotated andthreadably mated to the end effector 190. Second, the magnets, 194 m,196 m in combination with a pusher 198 a, can be used to actuate thejaws 192 a, 192 b. In the embodiment shown in FIG. 19, the magnet 196 min the end effector 190 is slidably movable along a longitudinal axis ofthe device, and it is coupled to the clevis 193 by a spring 195. Themagnetic force of the magnet 194 m on the distal end of the shaft 194will pull the magnet 196 m within the end effector 190 proximally. Thepusher 198 a can thus be used to push the magnet 196 m in the endeffector 190 distally to cause it to apply a force to the spring 195which in turn will move the clevis 193 distally within the actuatingsleeve 196, thereby closing the jaws 192 a, 192 b. While the pusher 198a can abut directly against the end effector magnet 196 m, in theembodiment shown in FIG. 19 the end effector magnet 196 m includes anabutment or protrusion 198 b formed thereon for seating the pusher. Inorder to release the end effector 190 from engagement with the shaft194, the shaft 194 can be threaded in an opposite direction to disengagethe shaft 194 from the end effector 190, and the pusher 198 a can beused to push the magnet 196 m in the end effector 190 away from and outof engagement with the magnet 194 m on the shaft 194.

The present invention also provides various exemplary methods fordelivering the end effectors to a body cavity. In one embodiment, shownin FIG. 20, the end effector can be disposed within a dissolvablecapsule 200. The capsule can be swallowed or otherwise introduced intothe patient whereby the capsule will dissolve leaving the end effectorin the body cavity, e.g., the stomach, for use. Alternatively, the endeffectors can be delivered endoscopically. FIGS. 21A-21D illustrate oneexemplary method for endoscope delivery of a plurality of end effectors.As shown, an endoscope 210 or other insertion device is first passedthrough a body lumen, such as through a patient's oral cavity andesophagus and into the stomach. A delivery wire 212 can be insertedthrough the endoscope 210, as shown in FIG. 21A, and the endoscope 210can then be removed leaving the delivery wire 212 in place, as shown inFIG. 21B. One or more end effectors 214 can then be advanced over thedelivery wire 212 and into the body cavity. A laparoscope 216 or theflexible endoscope can optionally be advanced over the delivery wire 212to help push the end effectors 214 into the body cavity. An overtube canalternatively be used to rapidly deliver multiple end effectors to abody cavity.

Once the end effectors 214 are in the body cavity, an elongate shafthaving various configurations can be inserted into the body cavitywhereby it can be used to interchangeably engage each of the various endeffectors to perform various surgical procedures. In one embodiment, theshaft can be delivered through the endoscope. In another embodiment, theshaft can be delivered laparoscopically, for example through an incisionformed in the stomach, to interchangeably engage the various endeffectors. By having all of the end effectors predisposed in the bodycavity, the patient does not to be re-intubated every time a new endeffector is required. Moreover, the procedure does not require a largeincision to be formed in the patient. In particular, the end effectorscan have a diameter that is larger than a diameter of the shaft to whichthey attach to. Since the end effectors are delivered endoscopically,the incision formed in the skin only needs to be large enough to receivethe shaft. Moreover, the particular configuration of the variousengagement mechanisms previously disclosed allows the end effectors tobe attached and detached to and from the elongate shaft without the useof additional tools for holding the end effectors. Once the procedure iscomplete, the end effectors can be removed endoscopically, passednaturally through the body, or using various other techniques.

A person skilled in the art will appreciate that, while not shown ordiscussed in detail with respect to each engagement mechanism, variousactuators can be used to effect movement of the various aforementionedengagement mechanisms. In general, one or more actuators can be coupledto a proximal end of a shaft, and movement of the actuator can beeffective to cause various actions at the distal end of the shaft, suchas attachment and detachment of an end effector to the shaft, andactuation of one or more portions of the end effector such as jawopening and closing, clip or staple advancement, energy delivery, etc.The particular action which results from movement of an actuator willnecessarily depend on the particular configuration of the device and theend effector. In an exemplary embodiment, the actuator is configured toallow a user to remotely effect an action at a distal end of the device.In particular, the distal end can be introduced into a body cavity whilethe proximal end extends from and remains external to the patient. Theproximal end can be actuated to cause movement at the distal end of thedevice, thereby allowing remote activation of the distal end. This isparticularly advantageous as additional tools and devices do not need tobe introduced into the body cavity to assist in attaching/detaching anend effector to/from the distal end of the device, and in actuating theend effector.

While virtually any actuation mechanism known in the art can be used,including levers, handles, knobs, etc., FIGS. 22A-22C illustrate certainexemplary actuators. FIG. 22A illustrates a handle 230 having a pivotingtrigger 232 formed thereon. The handle 230 includes a coupling mechanism234 extending between the trigger 232 and a proximal end of a shaft 236to be moved. Movement of the trigger 232 toward the handle 230, i.e.,into a closed position, is effective to cause the coupling mechanism 234to move proximally thereby pulling the shaft 236 proximally. As aresult, the distal end of the shaft 236 moves proximally. This can beeffective, for example, to pull a clevis proximally thereby pullingopposed jaws of a grasping or cutting device together. FIG. 22Billustrates another embodiment of a handle 240 having a pivoting trigger242 coupled thereto. In this embodiment, movement of the trigger 242toward the handle 240, i.e., to a closed position, is effective torotate gears 244 which cause a shaft 246 of the device to move distally.Distal movement of the shaft 246 could, for example, be effective toadvance a pusher distally thereby pushing an end effector out ofengagement with a distal end of the shaft. FIG. 22B also illustrates aknob 248 coupled to a proximal end of the shaft 246. Rotation of theknob 248 could, for example, be effective to rotate a distal end of theshaft 246 thereby threading the shaft 246 into a threaded bore in an endeffector, or performing other actions that require axial rotation. FIG.22C illustrates another embodiment of an actuator. In this embodiment, ahandle 250 is shown having a lever 252 coupled to a proximal end of ashaft 256. The lever 252 is adapted to slid proximally and distallyrelative to the shaft 256, thereby moving the distal end of the shaft256 proximally and distally. As with the handles shown in FIGS. 22A and22B, this movement could be effective to attach/detach an end effectorto/from a distal end of the shaft, and/or to actuate the end effector. Aperson skilled in the art will appreciate that a variety of otherhandles and actuators can be used to effect various movements of ashaft, including axial rotation and translation, as well as energydelivery.

The devices disclosed herein can also be designed to be disposed ofafter a single use, or they can be designed to be used multiple times.In either case, however, the device can be reconditioned for reuse afterat least one use. Reconditioning can include any combination of thesteps of disassembly of the device, followed by cleaning or replacementof particular pieces, and subsequent reassembly. In particular, thedevice can be disassembled, and any number of the particular pieces orparts of the device can be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thedevice can be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those skilled in the art will appreciate that reconditioningof a device can utilize a variety of techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of the presentapplication.

Preferably, the invention described herein will be processed beforesurgery. First, a new and/or used instrument(s) is obtained and ifnecessary cleaned. The instrument can then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK bag. The container and instrumentare then placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high-energy electrons.The radiation kills bacteria on the instrument and in the container. Thesterilized instrument can then be stored in the sterile container. Thesealed container keeps the instrument sterile until it is opened in themedical facility. It is preferred that device is sterilized. This can bedone by any number of ways known to those skilled in the art includingbeta or gamma radiation, ethylene oxide, steam.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A modular surgical device, comprising: aninstrument having a handle and an elongate shaft extending distallytherefrom, a distal end of the elongate shaft having one or moreresiliently deflectable members extending distally therefrom; an innershaft configured to advance through the elongate shaft to expand theresiliently deflectable members radially outward; and an end effectorhaving a first end with an opening formed therein configured to receivethe resiliently deflectable members thereinside such that theresiliently deflectable members can expand radially outward to engagethe end effector to mate the end effector to the instrument, and asecond end opposite to the first end and having a tissue effectingelement formed thereon for effecting tissue.
 2. The device of claim 1,wherein the elongate shaft of the instrument includes an actuatorconfigured to actuate the end effector.
 3. The device of claim 1,wherein the end effector includes a pair of jaws for grasping tissue. 4.The device of claim 1, wherein the end effector is selected from thegroup consisting of a needle, a snare, a needle knife, a monopolarprobe, a bipolar probe, a clipping device, a retractor, a band ligator,scissors, and graspers.
 5. The device of claim 1, wherein the endeffector comprises a plurality of end effectors matable to theinstrument.
 6. The device of claim 1, further comprising one or moreflanges on a distal end of each resiliently deflectable member andconfigured to engage the end effector.
 7. A modular surgical device,comprising: an instrument having a handle and an elongate shaftextending distally therefrom, a distal portion of the elongate shaftincluding deflectable arms and an expander element configured to movethe deflectable arms from a contracted position to an expanded position;and an end effector selectively and removably matable to the instrument,the end effector having a proximal end with a bore formed thereinconfigured to receive the distal portion of the elongate shaft of theinstrument thereinside such that the deflectable arms on the elongateshaft of the instrument engage the end effector in the expanded positionto mate the end effector to the instrument.
 8. The device of claim 7,wherein the elongate shaft of the instrument further includes anactuation shaft having a distal end that is matable to an actuator onthe end effector such that axial movement of the actuation shaftrelative to the elongate shaft causes actuation of the end effector toeffect tissue.
 9. The device of claim 7, wherein the end effectorincludes a pair of jaws for grasping tissue.
 10. The device of claim 7,wherein the end effector is selected from the group consisting of aneedle, a snare, a needle knife, a monopolar probe, a bipolar probe, aclipping device, a retractor, a band ligator, scissors, and graspers.11. The device of claim 7, wherein the end effector comprises aplurality of end effectors matable to the instrument.
 12. The device ofclaim 7, further comprising one or more flanges on a distal end of eachdeflectable arm and configured to engage the end effector.